UNBROKEN CHAIN

The following is an essay by a psychiatrist about his thoughts when his father, also a psychiatrist closed his office after over 50 years of practice. I worked with both of them while I was at New York Medical College and know them to be outstanding people

Unbroken Chain

After over fifty years of treating patients, my father, a psychiatrist, took down his shingle this week. He picked a day to stop practicing, saw his last few patients, stepped out of his office, closed the door and walked away. In the end, after thousands of forty-five minute sessions of talking, listening and helping, ironically, he said only, “it’s time to stop”. He was leaving behind a lifetime.

He was not turning back, but neither was he turning his back. Not on a half century of patients and their stories. Stories of sadness and of joy. Of wishes and fears. Misery and hope. Suffering and triumph. Bitter stories and sweet ones. Stories of despair and of fulfillment. Of accommodation and rebellion. Freedom and constraint. War stories and stories about making peace. Angry stories, guilty stories, lonely stories, and love stories. But mostly, stories about all the conflict and beauty in between. The stories of our lives.

How does one walk away from the relationships with patients? Patients with whom one has spent years together at sea. Straining, struggling, and delighting in intangible moments of connection that seem to hold much of the meaningfulness? How does one walk away from being immersed, day after day, year after year, in the winding and jagged paths, the various and sorted twists and turns of lives lived. And all of the sorrow, satisfaction, envy, frustration, pride, shame, angst, gratification, regret, and pleasure that comes with. Most of all, how does one walk away from the sheer privilege of sitting down with another human being, and together, trying to untangle it all.

We never know in this work, when a patient walks through the door for the first time, if this will be the one and only session we will have together, or if it will mark the beginning of a relationship that will span a good chunk of a century. Will they be here and gone in a relative instant, or will this person sitting with me today, a stranger, be a person I will come to know in some ways better than my own children and with whom I will grow old together.

One of the patients my father said goodbye to this week has been a patient of his continuously since 1965. When this patient walked in the door of my father’s office for the first time, Lyndon Johnson was president. The US troops were not yet on the ground in Vietnam. The patient, at the time, was in his twenties. He is now in his seventies, a grandfather.

How does the patient walk away from my father? A patient with such bad anxiety that it flirts with psychosis. He is often frightened and is delusional at times. For forty-seven years he has sought relief in my father. He trusts him. He is calmed by him. For the patient, what my father does is “magic”. Sometimes it helps to have magical thinking.

How does one even give up a decades old office phone number? A phone number that has traveled with my father to all of his many offices over the years. A number that I have known since I am a child. In the era before e-mail, websites and texting, it was through that one phone number that a career’s worth of patients reached my father. Originally on rotary phones, dialing it up in times of need, times of crisis, times of everything. It was through that number that my father put food on the table and as patients like to say, “sent his kids to college”. And it was through that number that all of the relationships, over all the years, began. The phone number was, in many ways, a lifeline.

So how does it all come to an end? How does the shingle, dripping with history and still pulsing with life, get put away? Not so easily. Not so fast.

As for the phone number? My father is now having the line installed in his home. He told me, “You never know when someone might want to call”. It strikes me that he is not installing the phone number at his home, but where he lives. He is staying connected. To who he is. To others. To being alive.

As for the patient, what will happen to him? Just as my father was reluctant to leave his patient, the patient, as one might imagine, was reluctant to leave him. As it turns out, my father will transfer the care of his patient to me, and he will now become my patient. Just before the termination of their relationship, after all the years, my father offered some final parting words of comfort to the patient he has known the longest, and with whom he has spent a lifetime. He said, with a knowing smile, “Don’t worry, my son has the magic too”. The words were comforting. To all three of us.

The next generation of talking and listening will carry on. Going forward, there will be more winding and jagged paths, more twists and turns, and more stories to tell, all told, as we move further, along an unbroken chain.

We live within each other. Within each other we live on.

Mark Singer
September 2012

Mark Singer,M.D. is an Assistant Professor of Psychiatry at New York Medical College and has a private practice in New York City and in Valhalla, NY. His email address is marksingermd@gmail.com
Paul Singer,M.D. is Professor Emeritus of Psychiatry at New York Medical College.